scholarly journals P.037 Role of epilepsy monitoring unit in the investigation of patients with epilepsy and developmental delay

2017 ◽  
Vol 44 (S2) ◽  
pp. S23-S23
Author(s):  
A Suller Marti ◽  
S Mirsattari ◽  
M Aldosari ◽  
K Ikeda ◽  
W Huang
Keyword(s):  
Developmental Delay ◽  
Focal Epilepsy ◽  
Epileptic Seizures ◽  
Increased Risk ◽  
The Mean ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy ◽  
Epilepsy Monitoring

Background: A significant part of the developmental delay (DD) population has epilepsy (26-70%) and live in an institution. These patients tend to have atypical presentation of epileptic seizures with higher risk of misdiagnosis. Distinguishing their ictal events from paroxysmal behaviors can be challenging.There often is a lack of description of the spells or inadequate history from the caregivers or the patients. These patients often have drug resistant epilepsy requiring polypharmacy with increased risk of morbidity and mortality. The aim of this study was to determine usefulness of Epilepsy Monitoring Unit (EMU) in diagnosis and management of these patients. Methods: This is a retrospective observational study of the patients with epilepsy and DD living in institutions that were admitted to the EMU. Results: Four patients met the inclusion criteria for this study. The mean age was 45(29-71), 3/4 (N=3) were male and 3/4 had focal epilepsy. All patients had mood disorders and 2 were taking antipsychotic medication. The mean admission-time was 6,25 days(2-15) and there was a correlation with the events and seizures in 2/4 of the patients and the rest had a combination of behavioural-changes and seizures. Conclusions: EMU admission can provide an accurate diagnosis of spells in patients with DD and epilepsy, and improve their quality of life.

Safety and Long-term Seizure-Free Outcomes of Subdural Grid Placement in Patients With a History of Prior Craniotomy

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 395-400 ◽  
Author(s):  
Sumeet Vadera ◽  
Lara Jehi ◽  
Jorge Gonzalez-Martinez ◽  
William Bingaman
Keyword(s):  
Focal Epilepsy ◽  
Seizure Onset ◽  
Initial Surgery ◽  
Increased Risk ◽  
Initial Procedure ◽  
History Of ◽  
The Mean ◽  
Drug Resistant Epilepsy

Abstract BACKGROUND: Patients who continue or begin to have seizures after brain surgery pose significant challenges and often require an invasive electroencephalographic evaluation before reoperation for drug-resistant epilepsy. The safety and seizure-free outcomes associated with subdural grid (SDG) implantation in patients with a prior craniotomy are important for both surgeon and patient to understand before pursuing further surgery. OBJECTIVE: To evaluate the safety of SDG placement and subsequent resective surgery in patients with prior craniotomy and to characterize the seizure outcomes and their predictors after resective epilepsy surgery in this unique cohort. METHODS: We retrospectively reviewed all intractable focal epilepsy patients with a history of craniotomy who underwent SDG insertion between 2000 and 2012 at our institution. A minimum follow-up of 6 months was required. End points analyzed included complications related to each surgery and Engel classification at the last follow-up. RESULTS: The mean age of seizure onset was 15.9 years, and the mean age for the initial surgery was 24.2 years. Only 3 patients began having seizures after the initial surgery. Seven patients (7%) had a complication associated with the SDG placement, and 15 (14%) had a complication after subsequent resection, which was equivalent to the initial procedure. Forty-eight patients (44%) were in Engel class I at the last follow-up. Freedom from seizures was predicted by ictal onset at the edge of the original surgical bed, particularly in patients with lesional epilepsy. CONCLUSION: Surgical intervention with SDG monitoring does not appear to be associated with increased risk of complications in epilepsy patients with a history of prior craniotomy, and rates of freedom from seizures in this challenging group are favorable.

scholarly journals Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units

2021 ◽  
Vol 12 ◽  
Author(s):  
Rodrigo Rocamora ◽  
Beatriz Chavarría ◽  
Eva Pérez ◽  
Carmen Pérez-Enríquez ◽  
Ainara Barguilla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Refractory Epilepsy ◽  
Depression Scale ◽  
Epileptic Seizures ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Patients With Epilepsy ◽  
Anxiety Depression ◽  
Epilepsy Monitoring

Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center.Materials and Methods: The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy (n = 395), psychogenic non-epileptic seizures (PNES) (n = 56), and combined (n = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life.Results: Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, p < 0.001) as well as pathologic HADS-A scores (p = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; p = 0.0027) and BDI > 13 (females = 56.6%, males = 41.0%; p = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups (p = 0.0015).Conclusions: Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

scholarly journals Epilepsy in Down Syndrome: A Highly Prevalent Comorbidity

2021 ◽  
Vol 10 (13) ◽  
pp. 2776
Author(s):  
Miren Altuna ◽  
Sandra Giménez ◽  
Juan Fortea
Keyword(s):  
Down Syndrome ◽  
Functional Outcomes ◽  
Clinical Presentation ◽  
Late Onset ◽  
Current Knowledge ◽  
Epileptic Seizures ◽  
Myoclonic Epilepsy ◽  
Increased Risk ◽  
Number Of Individuals

Individuals with Down syndrome (DS) have an increased risk for epilepsy during the whole lifespan, but especially after age 40 years. The increase in the number of individuals with DS living into late middle age due to improved health care is resulting in an increase in epilepsy prevalence in this population. However, these epileptic seizures are probably underdiagnosed and inadequately treated. This late onset epilepsy is linked to the development of symptomatic Alzheimer’s disease (AD), which is the main comorbidity in adults with DS with a cumulative incidence of more than 90% of adults by the seventh decade. More than 50% of patients with DS and AD dementia will most likely develop epilepsy, which in this context has a specific clinical presentation in the form of generalized myoclonic epilepsy. This epilepsy, named late onset myoclonic epilepsy (LOMEDS) affects the quality of life, might be associated with worse cognitive and functional outcomes in patients with AD dementia and has an impact on mortality. This review aims to summarize the current knowledge about the clinical and electrophysiological characteristics, diagnosis and treatment of epileptic seizures in the DS population, with a special emphasis on LOMEDS. Raised awareness and a better understanding of epilepsy in DS from families, caregivers and clinicians could enable earlier diagnoses and better treatments for individuals with DS.

scholarly journals Zinc deficiency may play a crucial role in dialysis-associated bacterial infections

2020 ◽  
Vol 11 (1) ◽  
pp. e9-e9
Author(s):  
Zahra Lotfi ◽  
Abbas Ali Zeraati ◽  
Elaheh Dashti ◽  
Tina Zeraati ◽  
Maryam Arghiany ◽  
...  
Keyword(s):  
Zinc Deficiency ◽  
Bacterial Infections ◽  
Critical Role ◽  
Serum Zinc ◽  
Zinc Level ◽  
Healthy Individuals ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
The Mean

Introduction: Systemic bacterial infections are a common cause of mortality and morbidity in hemodialysis patients. Zinc has a critical role in several immune system functions. Patients who have enough amounts of zinc are able to better face infections caused by various pathogens in comparison to those with zinc insufficiency Objective We sought to assess the role of zinc deficiency in dialysis-associated bacterial infections. Patients and Methods: Eighty-Three adult patients with end-stage renal disease (ESRD) on hemodialysis including 43 patients with bacterial infectious complications and 40 non-infected patients as well as 41 healthy individuals were enrolled. Clinical data, laboratory values including serum zinc level and imaging findings were collected. SPSS was utilized to analyze the data with a significance cutoff set at P < 0.05. Results: Out of 124 participants, 80 (64.51%) were males and 44 (35.49%) were females. The mean age of infected hemodialysis group, non-infected hemodialysis group, and healthy controls were 50.8 ± 16.25, 49.1 ± 18.1, and 56.3 ± 18.2 years, respectively. Catheter site infection (37.3%) and urinary tract infection (30.2%) were the most common infections. The mean serum zinc concentration was significantly lower in the infected patients, compared to non-infected patients and healthy individuals (P < 0.001). Conclusion: The ESRD patients on hemodialysis have lower serum zinc levels which are associated with increased risk of bacterial infection. The role of screening for zinc deficiency and use of supplemental zinc in these patients need to be studied.

scholarly journals The effects of epileptic seizures upon quality of life

2009 ◽  
Vol 15 (3) ◽  
pp. 110-113 ◽  
Author(s):  
Priscila Camile Barioni Salgado ◽  
Fernando Cendes
Keyword(s):  
Quality Of Life ◽  
Seizure Frequency ◽  
Seizure Control ◽  
Epileptic Seizures ◽  
Anxiety And Depression ◽  
Co Morbidity ◽  
Item Quality ◽  
Patients With Epilepsy ◽  
And Control

OBJECTIVE: understand the psychological considerations of the relationship between the effect of seizures upon the patients' perception of seizure control, depression, anxiety and quality of life (QoL). METHODS: 151 adult patients with epilepsy diagnosed for over two years were interviewed and responded the 31-Item Quality of Life in Epilepsy (QOLIE-31), the Trait Form of the State/Trait Anxiety Inventory (STAI II) and the Beck Depression Inventory (BDI). RESULTS: 45 patients were depressed (29.8%) and 29 (19.2%) had anxiety. Depression scores ranged from 0 to 49 (M=7.4; SD=8.9) and anxiety scores ranged from 19 to 69 (M=41.5, SD=11.9). Total QoL score was correlated to seizure control (p<0.001), perception of epilepsy control (p<0.001), anxiety (p<0.001), and depression (p=0.003). The perception of epilepsy control was correlated to seizure control (p<0.001), seizure frequency (p=0.001), anxiety (p<0.001) and depression (p<0.001). Seizure control was associated to anxiety (p=0.033) and depression (p<0.001). There was co-morbidity between anxiety and depression (p<0.001). CONCLUSION: This study highlights the importance of the seizure frequency and control to the evaluation of perception of epilepsy control and shows that anxiety and depression in epilepsy are predicted by seizure-related (seizure frequency and control) and psychosocial aspects (perception of control and QoL) together.

P–349 Does concomitant autoimmunity affect IVF/ICSI outcomes in women with endometriosis? A retrospective observational study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Rebecchi ◽  
N Salmeri ◽  
C Patruno ◽  
R Villanacci ◽  
P Rover Querini ◽  
...  
Keyword(s):  
Autoimmune Disease ◽  
Observational Study ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Retrospective Observational Study ◽  
Histopathological Diagnosis ◽  
Increased Risk ◽  
The Mean ◽  
Icsi Outcomes

Abstract Study question To investigate differences in In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) outcomes between endometriosis women who do or don’t have a concomitant autoimmune disease. Summary answer Despite a higher oocyte yield, a trend for reduction in clinical pregnancy rates was observed in the autoimmunity group compared to women without concomitant autoimmunity. What is known already Endometriosis is an inflammatory chronic gynaecological disorder with a known detrimental impact on fertility. Endometriosis pathogenesis is still unclear. It has been postulated a role of both innate and adaptive immune system. The coexistence of endometriosis and autoimmunity is a well-documented occurrence Some recent findings have revealed an increased risk to have concomitant autoimmune disease in women with endometriosis, but no study has so far investigated whether this association could affect IVF/ICSI outcomes. Indeed, autoimmune phenomena, including proinflammatory cytokines and auto-antibody production, may result in diminished quality of oocytes/embryos with lower pregnancy rates among these patients. Study design, size, duration This was a retrospective observational study carried out at the Fertility Unit of IRCSS San Raffaele Hospital (Milan). We reviewed medical patients’ notes of women with a confirmed diagnosis of endometriosis who referred to our Fertility Unit from October 2018 to January 2021. Participants/materials, setting, methods Out of 1441 patients undergoing IVF/ICSI, 98 women had surgical/histopathological diagnosis of endometriosis. 25 of them had a clinical and/or serological diagnosis of autoimmunity. Autoimmunity was assessed by clinical data (blood tests for auto-antibodies or rheumatological records) obtained from the electronic patient files stored in the database of our Fertility Centre. Clinical pregnancy was defined as the presence of at least one intrauterine gestational sac with a viable embryo at week 6 after transfer. Main results and the role of chance 25/98 (25.5%) endometriosis women with a concomitant autoimmune disease (cases) were compared with 73/98 (74.5%) endometriosis patients without autoimmunity (controls). The mean age was 37.36±3.63 and 36.93±3.79 (p=.623) in cases and controls respectively. The mean number of oocytes retrieved was higher in cases (5.78±4.07) than in controls (3.82±2.69;p=.041); similarly, cases showed an higher number of embryos (2.13±1.93 vs. 1.19±1.37;p=.041) and blastocysts (1.89±2.02 vs. 0.85±1.61;p=.041) obtained. A total of 47 fresh embryo transfer (ET) were performed. Considering all the endometriosis patients, the clinical pregnancy rate (CPR) per cycle was 34.0% (16/47); when stratifying for the presence of autoimmunity the CPR was 23.1% (3/13) in cases, and 38.2% (13/34) in controls (p=.494). Limitations, reasons for caution This is a retrospective study based on data extraction from electronic records of our Fertility Centre. The sample size is limited and some information about past medical history could be missed. Results should be interpreted with caution until validated by future research providing more standardized data collection. Wider implications of the findings: Despite significantly higher numbers of oocytes retrieved and embryos/blastocysts formed, the presence of concomitant autoimmune disease in patients with endometriosis may impair pregnancy rates. Whether this finding is confirmed and whether it could be due to a defect in embryo/blastocysts quality or in endometrial receptivity deserves further studies. Trial registration number Not applicable

scholarly journals The sociodemographic, clinical and pharmacotherapy characteristics influencing quality of life in patients with epilepsy: A cross-sectional study

2014 ◽  
Vol 05 (S 01) ◽  
pp. S007-S012 ◽  
Author(s):  
G. Ranjana ◽  
S. Dwajani ◽  
Chanda Kulkarni ◽  
G. R. K Sarma
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Seizure Frequency ◽  
Focal Epilepsy ◽  
Negative Influence ◽  
Monthly Income ◽  
Cross Sectional ◽  
Patients With Epilepsy

ABSTRACT Context: Quality of life (QOL) assessment in patients with epilepsy (PWE) is increasingly recognized as an important component in the management of epilepsy. Aims: The objective of the present study was to assess influence of sociodemographic, clinical and pharmacotherapy characteristics collectively on QOL in adult PWE. Settings and Design: This was a cross-sectional, observational study in patients with confirmed diagnosis of epilepsy. Materials and Methods: QOL was assessed using modified QOLIE-10 questionnaire for epilepsy. Univariate and multiple regression analysis were done to determine factors associated with poor QOL, respectively. Results: There were 451 PWE, with a mean age 27.3 ± 8.15 years, 251 (56%) males and 191 (42%) had monthly income < 5000 Indian national rupees (INR)/month. The QOLIE score was 64.1 ± 15.97 (Mean ± SD). The univariate analysis showed factors such as lower monthly income, focal epilepsy, seizure frequency, antiepileptic drug (AED) polytherapy, conventional AEDs and frequent adverse drug reactions (ADRs) had significant negative influence on various domains of QOLIE-10 questionnaire. Multiple regression analysis showed seizure frequency as a significant predictor of most QOL domains and overall score, while ADRs as a significant predictor of all the domains. Seizure type was a predictive factor for domains like emotional well-being and overall score. Conclusion: Present findings showed patients on monotherapy had better QOL while those having lower monthly income, having focal epilepsy and who received conventional AEDs had negative influence on QOL scores. Further, higher seizure frequency and occurrence of ADRs were significant predictors of all the domains of QOL in PWE.

scholarly journals Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle

Cartilage ◽  
2020 ◽  
pp. 194760352094636
Author(s):  
Yoshiharu Shimozono ◽  
John F. Dankert ◽  
John G. Kennedy
Keyword(s):  
Adipose Tissue ◽  
Advanced Stage ◽  
Arthroscopic Debridement ◽  
Posttraumatic Osteoarthritis ◽  
Significant Difference ◽  
The Mean ◽  
Grade 3

Objective To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle. Design A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated. Results A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 ( P = 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19) satisfied, 26.3% (5/19) neutral, 21.1% (4/19) unsatisfied, and 10.5% (2/19) very unsatisfied with their outcomes. The overall FAOS score demonstrated a significant difference in pre- to postoperative change with 14.8 for KL grade 3 and 5.9 for KL grade 4 ( P = 0.048). Conclusions Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.

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